Provider Demographics
NPI:1417033432
Name:BORGE, ALEYDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEYDA
Middle Name:M
Last Name:BORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 SOUTH FLAMINGO ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330
Mailing Address - Country:US
Mailing Address - Phone:954-252-8797
Mailing Address - Fax:
Practice Address - Street 1:5500 SOUTH FLAMINGO ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330
Practice Address - Country:US
Practice Address - Phone:954-252-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMEOO59138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11828Medicare ID - Type Unspecified
FLE80192Medicare UPIN